mind & body The Smart By Stacey Colino
When it comes to treating various health ailments, sometimes the pendulum swings one way…then the other…then back again.
For years, hormone therapy (HT)— either estrogen alone or combined with progestin—was seen as the panacea for pesky menopausal symptoms and possibly as a shield against diseases that often strike menopausal women. The tide turned when the initial findings of the Women’s Health Initiative (WHI), linking combined HT with a slightly increased risk of heart attacks, strokes, and breast cancer, were released in 2002. The results and the media frenzy that followed sent many menopausal women to their doctors in a panic over whether they should quit HT right away. In recent years, questions have
been raised as to how HT affects women depending on their age and where they are in the menopausal transition. For example, further analysis of the WHI found that women between the ages of 50 and 59 who took estrogen alone (conjugated equine estrogens) or
10 pause FALL / WINTER 2011
estrogen plus progestin actually had a 30 percent reduced risk of dying whereas women between 70 and 79 who took HT had a 14 percent increased risk of dying, although the results for women in their 70s weren’t statistically significant. It appears that “hormones may be less risky and perhaps even good for you if you start taking them early in menopause, but harmful if started many years after menopause,” says Nanette F. Santoro, MD, professor and E. Stewart Taylor chair of obstetrics and gynecology at the University of Colorado at Denver. According to experts, these
shifts in perspective are in part due to how the research was conducted and whom it was conducted on. A little background: “There were many observational studies from the 1980s, such as the Nurses’ Health Study, that showed that women who took estrogen had less heart disease, but one of the
Woman’s Guide to Hormone Therapy
major complaints about those studies is that the women who took estrogen might have been healthier to begin with,” says Isaac Schiff, MD, chief of the Vincent Obstetrics and Gynecology Service at Massachusetts General Hospital and the Joe Meigs Professor of Gynecology at Harvard Medical School in Boston. “In the 1990s, the WHI was conducted using randomized, controlled, double- blind trials—the gold standard for research—in which women were given hormones or a placebo, to see what, if any, effect hormones had on heart disease and other conditions; neither the physicians nor the patients knew what the women were getting,” Dr. Schiff continues. “When the WHI results came out in 2002, we were shocked to learn that combined HT did not prevent heart disease. In fact, it increased nonfatal heart attacks, strokes, and venous thromboembolic disease in the first few years of use, so the study was stopped. As it turned out, most of the heart events occurred in older women (the average age of women in the WHI trial was 63) so there was a trend for age. “In 2004, the WHI research
in women using estrogen alone came out,” Schiff continues. “Women using estrogen were more likely than women not using hormones to have a stroke or blood clots but did not have an increased risk of heart attack. Now, we’re trying to reconcile the observational studies, in which healthy women took hormones in their early 50s, with the randomized trials which studied older women, some of whom already had some heart disease.” Another complicating factor:
The earlier observational studies used Premarin® (a form of
Gary S Chapman/Photographer’s Choice RF/Getty Images
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